MAIL-IN DONATION FORM - American Red Cross

MAIL-IN DONATION FORM

Please print this form and complete the information below to ensure we can properly process and acknowledge your gift.

DONOR INFORMATION Donor Name (First Name and Last Name):_________________________________________________________________________________________ Organization Name (Fill this out only if you're making your donation on behalf of an organization): ____________________________________________________________________________________________________________________________

ADDRESS INFORMATION Address (If you're making this donation on behalf of an organization, please provide the company's address): ____________________________________________________________________________________________________________________________ City:__________________________________________________________________________________ State:______________ Zip Code:___________ Country:_____________________________________________________________________________________________________________________ Email (optional):_______________________________________________________________________________________________________________ Telephone Number (optional):___________________________________________________________________________________ o Home o Mobile By providing your email address and/or phone number, you will receive disaster news and alerts, preparedness tips and other ways to get involved with the Red Cross. You may unsubscribe at any time.

PAYMENT OPTIONS One Time Gift Amount: ________________________________________ o I'm enclosing my check made payable to the American Red Cross o Please charge my credit/debit card:

o Visa o MasterCard o American Express o Discover

Cardholder's Name: ___________________________________________ Card Number:________________________________________________ Expiration Date:_______________________________________________

OR Become a Red Cross Champion! Your monthly gift can make a meaningful difference.

o Y ES! Please bill my credit/debit card in the amount of $_____ per month.

o Y ES! I would like to make a monthly gift in the amount of $_____ using my checking account. I've attached a voided check from the account I would like to use.

Your monthly donation will be made each month from the payment option you selected. You may cancel or change this amount at any time by calling 1-800-RED CROSS (1-800-733-2767).

I WANT TO SUPPORT Please designate your gift to one of the following:

o W here It Is Needed Most: Support all of the urgent humanitarian needs of the American Red Cross.

o D isaster Relief: Help people affected by disasters big and small.

o Y our Local Red Cross: Provide for local Red Cross programs and services in your community.

o O ther* (please specify): _____________________________________ Please also indicate the name of the specific cause on the memo line of your check (for example: "Home Fires").

*If the American Red Cross is not raising funds for the specific cause you have indicated and/or donations exceed Red Cross expenses for that cause, your gift will be applied to Where It Is Needed Most.

Your questions and feedback are very important to us. Please feel free to contact us at or call 1-800-RED CROSS (1-800-733-2767). Thank you for your support.

Please mail this completed form to: American Red Cross | PO Box 37839 | Boone, Iowa 50037-0839

234501-02 6/19

RSG00000MCDF

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